Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OC005757L | PA |
NPI | 1003182098 |
---|---|
Provider Name | Mrs. Erin Mcandrew-Jervis |
First Address | Scranton, PA 18503-1555 |
Second Address | Scranton, PA 18503-1555 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2012 |
Last Update Date | 24/03/2012 |